Research Area : Health Services and Financing
This study report is based on a need-assessment survey conducted in connection with the BMC's plan to set up a municipal general hospital in one of its ward. The study area is unique in the sense that it is the most populous ward in Greater Mumbai, and yet, it does not have a single public hospital within its limits. Data was collected from 1,035 households spread across three health-post areas around the proposed hospital.
The study was able to bring out the utility of public health care services in the area, and to find out how the population copes with their health care needs when public health care services are not available in their locality. It is to be noted that this is a predominantly lower middle class and lower class population, which resides in the study area. In spite of not having a public hospital, for ailments reported during the reference period, about 30 per cent of the population had sought inpatient care services from the public sector outside the locality, and about 15 per cent had sought outpatient care services from BMC facilities. Though travel time and travel costs were higher, because of financial reasons the public were still seeking health care from public health care outlets outside their locality.
Analysis shows that non-availability of a public hospital was forcing about 44 per cent of the households to seek inpatient care services from the private sector, even if they were interested in seeking care from the public sector. Even the outpatient care services that were currently available in the area seemed to be inadequate, as 67 per cent of the households were having their need for outpatient care services unmet. When the poorest of the poor were left with no alternative but to seek care from public health care facility in other wards, others were “managing” with the services in the private sector where out-of-pocket expenses of treating an ailment was several times higher than that in the public sector. A majority of those who were currently “managing” their inpatient care needs through private hospitals, were willing to shift to the public health care system if made available in the locality. The study shows the need to strengthen the public health care system in order to maintain equilibrium in the country's health outcomes across different subgroups of population. The situation of the poor in rural areas will be even worse, as unlike in the case of their urban counterparts, which has been studied here (the poorest of the poor manage care from public hospitals in surrounding wards), they don't have an option to seek care from facilities of nearby localities.
Thus, it is recommend that the BMC must go ahead and set up the proposed hospital at the specified site. Further, given the high, unmet need of the people for outpatient care services, we recommend that the number of dispensaries available in the locality should be increased-- from one dispensary per 73,000 population to at least one per 40,000. In fact, it would be extremely cost-effective to strengthen the existing Health Posts (11 of them) in the locality to provide curative services (dispensary services), apart from the preventive health care services they presently provide. Such changes will help strengthen the public health infrastructure in the area and improve the image and credibility of the public health system run by the BMC.
Supported by: Oxfam Novib, The Netherlands
Team: T. R. Dilip, Ravi Duggal and Raman Kamble